Clinical and Microbiological Profile of Bacterial and Fungal Suspected Corneal Ulcer at University of Gondar Tertiary Eye Care and Training Centre, Northwest Ethiopia

Abstract

Background. A corneal ulcer is a major cause of monocular blindness in developing countries, including Ethiopia. Its etiology varies based on its geographical location and climatic conditions. Therefore, the main objective of this research was to assess the clinical and microbiological profile of suspected bacterial and fungal corneal ulcers at the Tertiary Eye Care and Training Centre at Gondar University. Methods. A cross-sectional hospital-based study of corneal ulcer cases was performed from February to October 2019. Sociodemographic and clinical data were collected using a standardized questionnaire. Corneal scrapings were used to classify bacterial and fungal pathogens. The specimens were inoculated on BHI media and sub-cultured on culture media for the separate cultivation of bacteria and fungi. Biochemical tests have been carried out to classify bacteria. Following CLSI, the antimicrobial resistance pattern of bacterial isolates was carried out. Wet mounting, Lactophenol cotton blue staining, and colony characteristics on SDA were used to classify fungal species. The data were analyzed with version 20 of the SPSS. Results. A total of 30 suspected bacterial and fungal keratitis patients have been enrolled in this study. The visual acuity presented in 90% of the affected eyes was in the category of blindness (<3/60). In 71% of the cases, clinically presumed risk factors were identified. Trauma was the most common risk factor found in 46% of cases, followed by keratitis exposure (13%). Of the corneal scrape tests, 76.6% were positive for bacteria and fungi. Fungi were identified in 53.3% of corneal ulcers followed by 33.3% of bacterial growth. The commonest fungi and bacteria isolated were Aspergillus species (69%) and S. aureus, respectively. The prevalence of Methicillin-resistant S. aureus (MRSA) was 2 (40%). The identified Pseudomonas species were susceptible to Gentamicin and Ciprofloxacin but resistant to Ceftriaxone. Conclusion. The primary microbial agents for corneal ulcers were fungi, and trauma was the most significant risk factor associated with corneal ulcers. To avoid chronic ocular morbidity and blindness, early identification of the etiologic agent and the provision of adequate management are recommended.

Microbiological profile of infective keratitis in a tertiary care hospital in north Karnataka

“…Present study the percentage of males affected 68.8% compared to females affected 31.2% and male female ratio 2.2:1, males were more affected may be due to more exposure outdoors and hard labour in dry dusty areas. This was in accordance with studies done by Waghmare AS et al, 11 Metha S et al, 13 Jayashree MP et al 16 Agricultural workers (50.3%) were most affected people in the present study due to exposure to the vegetative injuries because of nature of work, this was in line with studies done by Metha S et al 13 Vasudha CL, 15 Jayashree MP et al 16 Predisposing factors such as corneal trauma in our study was 54.12% followed by diabetes 34%, this finding was comparable with studies done by Waghmare AS et al, 11 Sharmila Raut et al, 12 Metha S et al, 13 Suwal S, 17 Gotekar R. B et al, 14 Jayashree MP et al, 16 Tarekegn Wuletaw et al 18 Percentage of vegetative trauma was 54.25% followed by Sand and dust 15.2%. Similar findings are seen in most of the studies done.…”

Clinical and Microiological Profile of Infective Keratitis in a Tertiary Care Hospital in North India

“…[13] and Saha S., et al [14] also reported Aspergillus and Fusarium to be the most commonly isolated fungal species. Similar results were reported by Basak SK., et al [15] and Wuletaw T., et al [16] as in their studies Aspergillus was the most common isolated fungus and among bacterial isolates Staphylococcus and Streptococcus were the most common identified bacteria.…”

The approach to diagnosis and management of corneal ulcers

“…Fungi are classified as yeast, filamentous septated, pigmented and non-pigmented, and filamentous without septae (Mabrouk et al, 2022). In temperate countries, yeast fungi like candida are widespread, but filamentous fungi like Aspergillus and Fusarium are more prevalent in tropical regions (Wuletaw et al, 2021). A host inflammatory response is triggered by the invasion of fungal infections, which can also enter the cornea following an epithelial rupture, trauma, or a foreign body in the form of vegetative material or soil particles.…”

“…Without ocular trauma, a corneal ulcer cannot form in a healthy person with a healthy ocular surface (Salmon, 2022). In this regard, a thorough history determining the patient's ulcer's underlying etiology is crucial for ensuring optimal care (Wuletaw et al, 2021). In the absence of trauma, a history of ocular trauma, ocular surgery, long-term ocular medication use (topical steroids, anti-glaucoma medications), contact lens wear (age of the contact lens and lens cleaning solution), and prior ocular infections are crucial.…”

“…Although any particular symptoms cannot identify the causative organisms, a comprehensive slit lamp evaluation combined with clinical expertise can lead to a likely diagnosis (Wuletaw et al, 2021). The aggressiveness of the infection can be determined by several characteristics, including size, shape, location of the infiltrate, involvement of the limbus and sclera, accompanied by an AC reaction, and hypopyon.…”